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In brief: Increasing costs, Netflix fame, Verma appointment

In brief: Increasing costs, Netflix fame, Verma appointment

WATERLOO, Iowa – VGM & Associates has sent a letter asking CMS, at minimum, to pay all HME providers in non-rural areas, including those in the 130 competitive bidding areas, the 75/25 blended reimbursement rates to help them offset increasing costs. 

“Since the onset of the COVID-19 pandemic, acquisition costs for many products have been rising steadily in the form of incremental price increases,” writes Clint Geffert, president of VGM & Associates in the Sept. 8 letter. “Fuel costs, delivery vehicle costs and labor costs have also been on the rise. Now, within the last few weeks, several major manufacturers of DME have announced yet another round of surcharges that have already been implemented or will be implemented within the next few weeks. The DME supplier community cannot absorb these price increases and continue to provider products to Medicare beneficiaries.” 

Only providers in non-rural, non-bid areas currently receive the 75/25 blended reimbursement rates through the public health emergency. 

That means, VGM points out, that providers in bid areas are receiving reimbursement that is: 1) tied to previous rounds of bidding; 2) derived via an auction methodology using a “median bid” vs. a clearing price; and 3) based on pre-pandemic demand and cost structure. 

“The HME provider community needs help in the form of higher reimbursement rates, and they need it immediately,” Geffert writes. 

Power seat elevation: NCART calls for signatures 

WASHINGTON – Reps. Jim Langevin, D-R.I., and Don Young, R-Alaska, are collecting signatures in the House of Representatives for a letter to CMS Administrator Chiquita Brooks-LaSure asking her to take the next step in increasing access to power seat elevation and power standing systems for Group 3 power wheelchairs, NCART reports. 

Right now, stakeholders are waiting for CMS to seek public comments on a request to reconsider the national coverage determination for mobility assistive equipment to include power seat elevation and power standing systems. The ITEM Coalition submitted the request to reconsider the NCD, in September 2020. 

NCART is asking stakeholders to use to contact their representative and ask them to add their name to the letter. The deadline for adding names is Oct. 1. 

Earlier this year, in July, Langevin and Young, co-chairs of the Bipartisan Disabilities Caucus, also sent a letter to Xavier Becerra, secretary of the Department of Health and Human Services, asking him to take the next step. 

Sun Medical launches new location offering broad array of services 

BIRMINGHAM, Mich. – Sun Medical Equipment and Supplies has opened a new Home Health Care Center in the “Triangle District” here.  

In addition to home medical equipment supplies and services, the new location will have nurses on staff to answer questions regarding home care evaluations, PCR COVID-19 testing for travel and other issues, and to host monthly “Ask the Nurse” seminars.  

“We know people want the best for their family and we’ve done our homework,” said John Jamian, COO. “Sun is carrying ‘physician recommended’ products, so our customers will have choices to what best fits their needs.” 

Sun Medical was founded in 1981 by Greg Jamian and Greg Boyajian and now has three locations in Washington Township, Troy and Birmingham. 

Over the years, Jamian and Boyajian have continued to expand their venture to include a private-duty nursing and home care company, a home infusion therapy pharmacy and a case management company.  

“We’re not done either,” said Jamian, CEO of parent company AmeriCare Medical. “We have another exciting venture coming that will complement our home health care services lines called Private Reserve Home Care.” 

Great Elm DME reports ‘positive momentum’ 

WALTHAM, Mass. – Great Elm DME reported revenues of $15.4 million for the fourth quarter ended June 30, 2021, compared to $13.9 million for the same period last year. Net income was $5.9 million vs. $2.8 million. 

For the fiscal year end, the company reported revenues of $57.6 million vs. $55.7 million, and a net loss of $2.5 million vs. a net loss of $0.1 million. 

Great Elm DME’s parent company, Great Elm Group, highlighted the completion of a holding company reorganization and financing transaction with J.P. Morgan Broker-Dealer Holdings Inc., that resulted in a $5 million distribution to GEG, lowered the cost of capital for the DME busienss and provided additional capital for acquisition opportunities. 

“We continue to build on the positive momentum in all aspects of our business,” said Peter Reed, CEO. “During the fiscal year, we entered into a transformative transaction with JPM which resulted in a distribution to GEG, lowered DME’s cost of capital and provided additional liquidity for future acquisitions.” 

During the fourth quarter, Great Elm DME completed the acquisitions of Advanced Medical DME, LLC and PM Sleep Lab, LLC (AMPM), providers of sleep testing, PAP and other respiratory products and services in nine locations throughout Kansas and Missouri. 

After the close of the fiscal year, Great Elm DME acquired the power mobility assets of MedOne Healthcare LLC (MedOne), enhancing its offering in that product category and expanding its geographic reach. 

Tactile Medical buys AffloVest 

MINNEAPOLIS – Tactile Medical has acquired the assets of the AffloVest respiratory therapy business from International Biophysics Corp., a privately held company that developed and manufactures the portable, wearable vest. 

AffloVest is used to treat patients with chronic respiratory conditions such as COPD-associated breathing conditions like bronchiectasis, or conditions resulting from neuromuscular disorders and cystic fibrosis, by managing airway clearance. 

“The addition of AffloVest represents an ideal strategic fit for Tactile Medical as it aligns well with our focus of treating patients with underserved chronic conditions in the home,” said Dan Reuvers, president and CEO of Tactile Medical. “We expect to promote AffloVest’s patented, portable design, demonstrated clinical outcomes, and established reimbursement within the DME channel to drive AffloVest to contribute to our overall company goal of 20%-plus revenue growth going forward. Like lymphedema, the chronic pulmonary disease market represents a large, and still underpenetrated opportunity. Importantly, multiple members of our management team have significant experience in this category, which gives us confidence in our ability to execute our commercial strategy for AffloVest.” 

Tactile Medical has financed the transaction through a combination of cash on hand and $55 million of borrowings under its existing credit facility, which is being amended in connection with the transaction.  

The company says its strategic rationale for acquiring AffloVest includes adding a $5 billion annual addressable market opportunity in the United States, with expected gross margins above 70% and adjusted EBITDA margins of more than 30%. 

Tactile Medical’s offerings include pneumatic compression devices, as well as continuity of care services provided by a national network of product specialists and trainers, reimbursement experts, patient advocates and clinicians. 

Inogen juices clinician sales 

GOLETA, Cailf. – Inogen has announced an agreement with Ashfield Healthcare to enhance its go-to-market capabilities. 

Per the agreement, Ashfield will add about 20 dedicated sales representatives to Inogen’s prescriber sales organization and provide the company access to its proprietary insights and data, including the specialized health care intelligence platform, to support growth and drive performance in the clinician sales channel. 

“Forming this relationship marks an important milestone in our strategic plan of improving market penetration for portable oxygen concentrators (POCs) with one of the most critical constituents, the clinicians,” said Nabil Shabshab, CEO and President. “By enhancing our coverage of select clinicians and increasing our collaboration with health care prescribers overall, we will raise awareness of the importance of the POC’s role in oxygen therapy and of Inogen’s leading offerings. We believe this will further enhance our ability to better serve oxygen therapy patients right at the start of their diagnosis and ongoing to maximize the impact we can deliver.” 

Ashfield Healthcare, part of UDG Healthcare, an integrated health care services partner, offering services across strategic consulting, benchmarking, commercialization, customer engagement, events, marketing and communications. Its clients include top 30 global pharmaceutical companies. 

Harmar expands manufacturing  

SARASOTA, Fla. – Harmar Mobility is moving to a new facility that’s just one mile away but that increases its square footage by 60%. 

The company, which has expanded over the past year from 195 to 220 employees, needs more room not only for its corporate offices but also for its manufacturing plant, which houses 40 tons of equipment and which will see a 44% increase in square footage at the new facility. 

“Our employees’ happiness and comfort are extremely important to us,” said Harmar CEO Steven Dawson. “Which is the biggest reason for staying as close to our original facility as possible. Our team members are used to the commute, used to the area—we didn’t want to lose anyone because the new location is too long a drive.”  

The new facility also provides, among other things, double the conference room space, a training room for dealers, and a photography and videography studio. 

While the offices are already in use, Harmar’s team continues to prepare the new facility to house all of its equipment, as it needed significant upgrades to electrical, lighting and ventilation. The company has been sending over equipment to the facility in stages, over a series of weekends. 

“It’s a big move for a short distance,” said Joe Ayette, vice president of operations. “We officially began the move in October of 2020, but it obviously was in the works well before then.” 

Harmar plans to have the move complete by fall. 

Tranquility Briefs steal scene in Netflix show 

DUNBRIDGE, Ohio – Tranquility Briefs recently achieved Netflix fame through a mention in its original series, “The Chair.” In the fourth episode of the series, actor Bob Balaban, who plays an aging American-lit professor experiencing incontinence, expresses his frustration with being seen as irrelevant. He tells his wife, “I used to bestride the world like Colossus.” His wife wields a package of adult diapers and replies, “Well, now you’re going to bestride it in Tranquility Briefs.” “Having our Tranquility brand of products mentioned by name was both a surprise and an incredible honor for our small, Midwest business and the people we serve,” said Andy Stocking, president and CEO of Principle Business Enterprises, Inc., (PBE), manufacturer of Tranquility. “The scene brings to light an extremely personal reality that millions of people, and their partners or caregivers, experience daily.” An estimated 44.8 million U.S. adults – one in six adults – live with incontinence, according to third-party research commissioned by PBE. An additional 9.5 million adults are caregiving for someone with incontinence. PBE began manufacturing Tranquility products over 30 years ago after recognizing the need to provide those with incontinence the means to continue living their everyday lives with peace-of-mind. 

Ventec receives PDAC classification 

BOTHELL, Wash. – Ventec Life Systems has had its standalone V+Pro ventilator added to the Pricing, Data Analysis and Coding (PDAC) Product Classification List under the Health Care Procedure Coding System (HCPCS) as reimbursable under codes E0465 or E0466. “Providing a family of products for patients and their caregivers is an essential element of Ventec Life System’s operational objectives, especially when ventilator demand is at the forefront due to the COVID-19 Delta variant,” said Jim Alwan, president and CEO. “And with the addition of our V+Pro ventilator to our product portfolio, providers now have access to alternative respiratory products which they have not had before.” The V+Pro ventilator provides invasive, non-invasive and mouthpiece ventilation, and is a critical care ventilator approved for use in hospitals, skilled nursing facilities and home care for adult and pediatric patients greater than 5 kilograms.  

Hayat Pharmacy first repeat winner 

IRVING, Texas – Hayat Pharmacy, part of the Health Mart franchise, has been named Health Mart Pharmacy of the Year, its second time earning the honor and the award’s first-ever repeat winner. The award is given to top-performing pharmacies for superior clinical performance, high-touch patient relationships and proactive advocacy efforts. “We started our pharmacy with the goal of providing quality health care to the traditionally underserved,” said Hashim Zaibak, who owns the pharmacy along with Tamir Kaloti. “It is a tremendous honor to be recognized for our patient care and deep ties to the community. We understand the importance of focusing on each patient’s individual needs and are committed to enriching communities with excellent, compassionate and affordable care that people deserve.” Zaibak and Kaloti operate 19 pharmacies in the Milwaukee area. The pharmacy team combines innovative technology solutions and strong community focus to address multiple health care needs – from point-of-care testing and compliance packaging to custom-fitted durable medical equipment to a robust Med Sync program with thousands of patients enrolled. 

Verma joins WellSky board 

OVERLAND PARK, Kan. – Seema Verma, former administrator of CMS, has joined WellSky’s board of directors. Verma’s experience creating national health care policies and developing technology standards will accelerate WellSky’s mission to transform care at every level, the company says. “Seema is a nationally recognized health policy expert equipped with a deep understanding of the complexities of the health care industry,” said Bill Miller, WellSky CEO. “With the addition of Seema to our board, WellSky and our clients gain a fierce advocate and thoughtful leader who will elevate and champion our vision to advance innovative solutions that arm providers, health systems and payers with the tools to succeed in the world of value-based care.” As administrator from 2017 to 2021, Verma implemented more than 16 initiatives aimed at transforming the American health care system to lower costs, improve quality and increase access to care. She accelerated the value-based care transformation, backed new care models like acute hospital at home, and addressed social determinants of health by advancing new payment models. 

OPGA names O&P Woman of the Year 

WATERLOO, Iowa - The Orthotic and Prosthetic Group of America, a division of VGM & Associates, has named Ashlie White, director of health policy and strategic alliances for the American Orthotic and Prosthetic Association, as its O&P Woman of the Year. Prior to joining AOPA, White served as director of operations for Beacon Prosthetics and Orthotics. She also served eight years as the director of government affairs for the North Carolina Orthotics and Prosthetics Trade Association, NCOPTA, and four years on the board of directors for the National Association for the Advancement of Orthotics and Prosthetics. 

Braze Mobility joins VA Innovation Network 

WASHINGTON – Braze Mobility is one of 10 companies selected to join the Veterans Health Administration Innovation Network to develop innovative solutions. Braze Mobility is developing a terrain analysis system to help wheelchair users navigate outdoor environments more safely and independently using proprietary machine-learning algorithms that identify hazards. “I am excited to share that we will be collaborating with #VHAInnovation to bring our innovative sensor technology for wheelchairs to veterans across the U.S.,” said Pooja Viswanathan, founder. “We are fortunate to have had the VA as an early adopter of our technology, and are thrilled to be able to continue working closely with them to improve the lives of veterans.” 

MasVida Health combines three companies 

FORT WORTH, Texas – Three health care-focused companies, JMeds, EMist and Teleos Marketing, have joined together under a flagship company MasVida Health. The partnership and rebranding strategy, which includes a new company logo and website, enhances operational efficiencies and reflects the evolution of the company, according to a press release. “By combining our three companies, we now provide solutions across the health continuum – from helping health care professionals create, communicate and provide value to their target markets and HQAA-certified DME to innovative infection prevention solutions and advanced electrostatic sprayer technology,” said MasVida Health CEO Joshua Robertson. “We enrich lives and empower excellence enabling better care at a lower cost.” MasVida Health Care Solutions, formerly JMeds, has served post-acute facilities in Texas for nearly 25 years. The company provides DME, including its DME Pro + and DME Platinum programs, with same day, guaranteed delivery in Texas. It also provides an infection prevention suite called MViP (MasVida Infection Prevention) to differentiate a post-acute care facility’s cleaning, disinfection and infection prevention processes. “MasVida Health Care Solutions delivers same-day DME,” said Jenny Swain, executive vice president of sales and clinical initiatives. “And we provide the first and only end-to-end IPC program that can uniquely position a facility beyond their competition.” EMist manufactures smart electrostatic sprayers, and Teleos Marketing develops measurable campaigns for everything from medical devices to pharma, post-acute care to cloud-based ERP. 

Motion hits 49 locations 

TORONTO – Motion, formerly Motion Specialties, has expanded its mobility and home accessibility business across Saskatchewan, with the acquisition of Golden Mobility & Rehab. The company now has 49 locations across five Canadian provinces. “Despite the ongoing challenges of the COVID-19 pandemic, our business has had tremendous expansion over the last nine months through the addition of North Coast Home Medical Equipment (Terrace, B.C.), A-1 Wheelchairs Unlimited (Langley, B.C.) and most recently Canadian Health Care Products Ltd. (Winnipeg, MB),” said Thecla Sweeney, executive chair & CEO, Motion. “We started the year off with a plan for aggressive growth and we couldn’t be more pleased to continue this momentum with the integration of Saskatchewan’s largest mobility business, Golden Mobility & Rehab Ltd.” Golden Mobility & Rehab has been in business for more than 31 years and provides sales, service and support across five locations in Saskatoon, Regina, Prince Albert, Yorkton and Moose Jaw. The company also broadens Motion’s comprehensive offering in the region to include vehicle conversion and adaptive driving controls. 

Soleo Health tapped by health system to provide mAb therapy at home 

FRISCO, Texas – Soleo Health has been selected by Houston Methodist to provide monoclonal antibody therapy (mAb) to COVID-19 patients in their homes. The hospital system is among the nation’s largest providers of mAb therapy and has a partnership with the U.S. Department of Human Services, supported by KPMG LLP, to expand access to the treatment to underserved and disadvantaged patients in the greater Houston area. “By teaming up with Houston Methodist to help patients receive therapy and stay in their homes, we are helping reduce the chance of increased infections and the spread of COVID-19 in a hospital setting,” said Shahram L. Badrei, Pharm.D, R.Ph, regional business leader at Soleo Health. “Our relationship with Houston Methodist allows Soleo Health to service a vulnerable population and prevent the spread of the virus. Contributing to the public health and safety of the Houston community is truly important to our company, which is also a Texas-based entity. We look forward to being part of the pandemic solution through this exclusive agreement.” Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens such as viruses. If administered within 10 days of onset of COVID-19 symptoms, the one-time therapy is effective in neutralizing the virus and preventing symptoms from worsening. The treatment is administered through intravenous infusion, delivering medication directly into a patient’s bloodstream. 

DOJ says telemedicine responsible for bulk of latest fraud takedown 

WASHINGTON – The Department of Justice has announced criminal charges against 138 defendants for their alleged participation in various health care fraud schemes, including those involving telemedicine and DME, that have resulted in about $1.4 billion in alleged losses. 

Of the total, 43 defendants have been charged for their participation in schemes involving telemedicine, resulting in $1.1 billion in alleged losses. Certain telemedicine execs allegedly paid doctors and nurse practitioners to order unnecessary DME, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen, according to court documents.  

The focus on telemedicine fraud, the DOJ says, builds on the impact of the “Operation Brace Yourself” takedown in 2019, which resulted in an estimated cost avoidance of $1.9 billion in the amount paid by Medicare for orthotic braces in the 20 months following the takedown. 

Viemed adds to evidence for NIVH 

LAFAYETTE, La. – Patients with COPD and CRF who were prescribed noninvasive ventilation at home had statistically significant reductions in risk of death (38.3%), hospitalizations (21.0%) and ED visits (42.9%) compared with similar patients not treated with NIVH, according to a new study from Viemed Healthcare. The study, which was published Sept. 15 in the online edition of The American Journal of Managed Care, also shows NIVH is associated with a one-year risk difference of 13% for mortality, 8.4% for first hospitalization and 17.6% for first ED visit, yielding relative risk reductions of 30.7%, 12.9% and 20.1%, respectively. “We are very pleased to once again see published evidence that supports the clinical efficacy of NIVH on the highest risk, chronically ill respiratory patients, and are excited to continue to share these results with the medical community,” said Casey Hoyt, Viemed’s CEO. “These results confirm the findings of a separate study published in December 2020, which used different statistical methods and studied a different patient population than that used in the current study.” All data for the study was obtained from the Medicare Limited Data Set and included patients who were diagnosed with COPD and CRF between 2012-17. 

AdvaMed disagrees with administration on ‘breakthrough’ technology 

WASHINGTON – AdvaMed says the administration’s decision to fully repeal a final rule on Medicare Coverage of Innovative Technology is “unfortunate.” In a statement, AdvaMed President and CEO Scott Whitaker said the federal government should be providing incentives to access new breakthrough technologies. “Any Medicare patient and their doctor who has exhausted all existing medical options should have immediate access to FDA-approved breakthrough medical technologies,” he said. “Repealing MCIT is the wrong decision for countless Medicare patients, and it’s the wrong decision for American medical innovation. Our goal in this country should be to spur and not inhibit innovation that will change patient’s lives. We will continue to make this important case with the administration and Congress, and we are hopeful they will make the right decision.” CMS did say that it intends to conduct future rulemaking* to expediate a coverage pathway for innovative technologies (balanced with evidence development to ensure beneficial health outcomes for beneficiaries). Under the final rule, Medicare would have provided immediate national coverage for four years for any new device or diagnostic designated as a “breakthrough” technology and deemed safe and effective by the U.S. Food and Drug Administration. During that four-year coverage period, manufacturers could continue to provide the additional data needed to maintain coverage after the four-year coverage period expired.  

LUCI partners with Motion Concepts 

NASHVILLE, Tenn. – LUCI and Motion Concepts, the Canadian-based seating and mobility subsidiary of Invacare, have announced an agreement to make LUCI’s safety technology system available to riders of the ROVI X3 power wheelchair. The companies are targeting to make the product available across the United States before the end of the year. “We’re always listening to our riders, and we’ve heard from many who want LUCI on their chair,” said Ann Quigley, vice president of sales. “LUCI’s safety features will allow X3 users to be more in control and more independent in their day-to-day lives, ultimately offering a richer mobility experience.” The LUCI safety system, which is fully compatible with alternative drive control devices, such as head array or proximity switch tray, uses cameras, radar and ultrasonic sensors to help prevent wheelchair accidents, including collisions, tip-overs and or curb drop-offs. LUCI has similar partnerships with a number of other power wheelchair manufacturers. “We’re thrilled to form this partnership with Motion Concepts, introducing LUCI to more riders,” said Barry Dean, co-founder and CEO. 

Pediatric Home Service taps new CEO 

ROSEVILLE, Minn. – Pediatric Home Service has named Adam Nielsen as its CEO, succeeding Cameo Zehnder, who remains chief administrative officer. “PHS has a long history as a Pediatric Center of Excellence and making a difference in the lives of children and their families,” said Nielsen. “It is an honor to be a part of a team that is delivering on this mission.  I look forward to working with the talented leadership at PHS as we scale best practices and deliver more care to children in our current communities and across the country.” Neilsen most recently served as chief strategy & development officer for the Center for Diagnostic Imaging (now Rayus Radiology), one of the nation’s leading providers of diagnostic imaging. Prior to CDI, he served as CEO of Great Lakes Caring, a provider of home health and hospice services, where he led expansion and acquisition efforts. During his time at Great Lakes Caring, Nielsen was named one of Glass Door’s Top 100 CEOs.  

Coalition for PBM Reform launches 

WASHINGTON – The National Community Pharmacists Association has partnered with five other organizations to form the Coalition for PBM Reform to bring transparency to a part of the health care system that they say is dominated by a few giant corporate middlemen who price medicines, reimburse pharmacies, and determine how much patients will pay at the counter. “Transparency is essential to any healthy market,” said B. Douglas Hoey, NCPA CEO. “There is none in the prescription drug market. Americans pay the highest drug prices in the world. And we’re the only country that has turned over prescription drugs to PBMs. We don’t think that’s a coincidence.” Other members of the coalition, which represents independent pharmacies, grocery stores, chain pharmacies, small businesses, health care providers, and patients, include the FMI - Food Industry Association (FMI), the AIDS Healthcare Foundation (AHF), the National Federation of Independent Business (NFIB) the Coalition of State Rheumatology Organizations (CSRO), and the Community Oncology Alliance (COA).


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